Pneumonia is a type of acute infection that causes inflammation of the lungs. It can be caused by a wide variety of microorganisms – bacteria, viruses or fungi.

The lungs are made up of small ‘sacs’ called alveoli that, in the case of healthy people, fill with air when breathing. In contrast, the alveoli of people with pneumonia are filled with pus and fluids, which makes breathing painful and limits oxygen absorption.

Pneumonia is a common disease that occurs annually in 5%-11% of the population. It is most common in males, at the ends of life, in winter and in the presence of various risk factors. It may occur mildly, but the need for hospital admission increases with age.

Medium- and long-term mortality is high and pneumonia is in fact the leading cause of infectious disease death in the world and the sixth overall. In addition, it is the leading cause of infant mortality worldwide.

Types of pneumonia

Depending on where and when it has been contracted, pneumonia is classified as:

• Community-acquired (or out-of-hospital) pneumonia. It is contracted outside the hospital environment, in the day-to-day life of the patient, due to infection by different microorganisms (mainly bacteria and viruses).
• Hospital pneumonia. It is contracted within the hospital environment, during or after a stay in a health care facility such as hospitals or dialysis centers. It tends to be much more severe, as the patient’s defense mechanisms are often affected and the causative microorganisms are often much more resistant to antibiotics. Pneumonia associated with mechanical ventilation is included in this group.

The bacteria and viruses that often cause community-acquired pneumonia are different from those from the hospital environment, so it’s very important to know the specific cause of pneumonia in order to apply appropriate treatment.

Who is affected by pneumonia?

According to the World Health Organization, in 2015, pneumonia was responsible for 15% of deaths in children under 5. It is therefore a dangerous disease in young children, which is why the WHO recommends vaccination to prevent pneumonia.

According to the Quebec Lung Association, 200,000 to 300,000 Canadians suffer from pneumonia each year and the death rate can reach 30% in certain populations (elderly people – over 65 years old – hospitalized, etc.). Hospital acquired pneumonia affects 0.5% to 1% of hospitalized patients, but up to 40% of people on mechanical ventilation in intensive care.

What causes pneumonia?

When a person’s defenses are weakened, they are more susceptible to infection by microorganisms, whether they are bacteria, viruses or fungi.

Bacteria are the most common cause of pneumonia, and within them, streptococcus pneumoniae, also known as pneumococcus, is the most common. Atypical pneumonia, caused by other bacteria, can also occur, which is often left unidentified. Third, the bacterium Pneumocystis jiroveci mainly affects people whose immune systems are not functioning well.

Viruses are also a common cause of pneumonia; for example, influenza, chickenpox, measles or cough.

How does the infection occur?

The most common mechanism by which an infectious germ invades lung tissue is the aspiration of microorganisms from the upper airways. Other microorganisms reach the lung from the inspired air, while others from other regions of the body, such as the bile ducts, urinary system, or heart valves, reach the lung through the bloodstream.

Risk factors

There are several factors such as alcohol and tobacco use, malnutrition, or uremia or chronic obstructive pulmonary disease (COPD) that promote its onset. Specifically, the following factors increase your chances of developing the disease:

• Being over 65 years of age or be under 5. Age is not a risk factor in itself, but it is associated with situations that favor pneumonia.
• Being a smoker. Smokers are 51% more at risk than the non-smoking population
• Alcoholism.
• Malnutrition.
• Having s chronic lung disease such as COPD (Chronic Obstructive Pulmonary Disease), asthma, or cystic fibrosis.
• Suffering other serious conditions such as cirrhosis of the liver, diabetes or heart ailments.
• Having dementia, stroke, injury or cerebral palsy or other brain disorders.
• Immune system problems requiring, for example, cancer treatment or immune diseases such as HIV infection or AIDS.
• Having recently had surgery or trauma.

Also, poor oral hygiene can increase your chances of getting pneumonia, because the microorganisms that live in your mouth can increase if your mouth isn’t cleaned properly.

What are your symptoms?

The symptomatology of community-acquired pneumonia is non-specific and its diagnosis is based on a set of symptoms related to a lower respiratory infection and general condition involvement. This includes the following signs:

• Fever
• Cough
• Expectoration
• Chest pain
• Difficulty breathing

In the elderly, the absence of fever and the onset of confusion and worsening of underlying diseases are not uncommon.

In general, there is no characteristic, clinical sign, or combination to deduce which microorganism is causing pneumonia.

What complications can pneumonia cause?

If severe, pneumonia can lead to death, so it’s best to stay alert and make a quick diagnosis to treat it as soon as possible.

Rarely, the following complications may occur:

• Fluid around the lung (pleural effusion).
• Infected fluid around the lung (empyma).
• Pulmonary abcesses.

How is pneumonia diagnosed?

To make the diagnosis, the doctor examines the patient’s chest with the stethoscope for abnormal noises such as creaking or bubbling noises. If pneumonia is suspected, a chest x-ray is then done to confirm the diagnosis.

Other possible tests include culture of sputum and blood samples to identify the responsible microorganism, chest tomography, arterial gasometry (measurement of blood oxygen concentration) or a blood test.

Physicians use different scales by adding up data from gasometry, breathing rate, blood pressure, radiographic signs, or the patient’s age to determine whether the patient’s hospital admission or other care measures are necessary.

How is pneumonia treated?

Depending on the severity of the disease, treatment may be done on an outpatient basis, at the patient’s home, or require hospital admission of the patient, which happens in 30% of cases.

Depending on the microorganism causing pneumonia, antibiotics or antivirals are given to the patient orally; the latter, especially if the patient has the flu. If hospital admission is necessary, these same medicines are given intravenously. Fluids may also be given through this route to alleviate dehydration caused by the various symptoms of pneumonia. In any case, the patient with pneumonia should drink plenty of fluid (water, juices or clear teas).

After treatment, full recovery can take from a few days to several weeks, depending on the patient’s age and the severity of the disease.

10 Tips to Prevent Pneumonia

Pneumonia is an infectious disease that can become very serious, but in some cases it can be prevented.

• Stop smoking

It is scientifically proven that abandoning the smoking habit prevents pneumonia, as tobacco damages the lung’s ability to fight infection. Passive smokers are also at increased risk of contracting it, so it is advisable not to be exposed to cigarette smoke. Quitting smoking is the first preventive measure against this pathology.

• Get vaccinated against the flu

People who are at the greatest risk of getting pneumonia should get vaccinated against the flu every year: the elderly, patients with chronic diseases or healthcare professionals in contact with patients, etc. This vaccine, which has to be administered annually following the recommendations and strains reported by the World Health Organization (WHO), does not fully protect against influenza, but it does make it more difficult to contract it within six months of its application.

• Get vaccinated against pneumococcal

It is the microorganism that most often causes bacterial pneumonia, so being vaccinated against it effectively prevents it. The vaccine is indicated for people over 65 years of age and people at high risk (with chronic diseases or immune deficiencies) over 2 years of age and revaccination is recommended in people over 65 years of age if at least 8 years have elapsed after the first vaccination.

• Seek medical advice immediately for the first symptoms

Pneumonia can be treated and cured, but it can also become a serious and sometimes fatal disease. Especially the at-risk population should pay attention to symptoms and not wait to go to the doctor. Under no circumstances should you self-medicate.

• Faithfully follow the treatment prescribed by the specialist

Especially in the case of antibiotics, you should not miss any doses, and take the drug until it is finished, even if you start to feel better. Unless prescribed by your doctor, do not take antitussives or cold medications.

• Nourish your defenses

Proper nutrition is key to improving natural defenses for both adults and children. For children, exclusive breast milk feeding for the first six months of life, in addition to effectively preventing pneumonia, reduces the duration of the disease. And for everyone, a healthy lifestyle, a balanced diet, exercises and plenty of rest helps make us more resistant to infections.

• Keep you environment under control

The number of children who develop pneumonia can also be reduced by correcting environmental factors such as indoor air pollution (e.g. avoiding smoking inside the house) and by promoting proper hygiene in overcrowded households.

• Take care of your hygiene

It is very important that we wash our hands frequently, especially before cooking, after blowing our nose, going to the bathroom, changing the diaper of a baby or being in contact with sick people. We should also cover our mouths when coughing or sneezing, putting on a disposable handkerchief or sneezing or coughing onto the inside of the elbow, better than with the hand.

• Try not to spread the disease

If you are going to visit a patient who has hospital pneumonia, it is necessary to follow the regulations established by the hospital to avoid spreading the disease or increase the risk of the sick person. So, if you’re recommended to wear a mask or wash your hands when entering or leaving the room, follow the recommendations. And in the event that you are the sick person, limit as much as possible your contact with other people.

• Be patient

Healing this disease may be slow. Approximately 70% of patients will be asymptomatic within 10 days and will have radiological resolution within 30 days of diagnosis. But if this is not the case, new tests and complementary studies will be carried out.